De-Madaria E.,Hospital General Universitario Of Alicante |
Palazon J.M.,Hospital General Universitario Of Alicante |
Palazon J.M.,CIBER ISCIII |
Hernandez F.T.,Farmacologia Clinica |
And 16 more authors.
European Journal of Gastroenterology and Hepatology | Year: 2010
Background and Aim: Prophylactic treatment of variceal bleeding in cirrhotic patients with β-blockers is effective in only some patients. Our aim was to determine whether the response of the hepatic venous pressure gradient (HVPG) to the intravenous administration of propranolol predicts the response after chronic oral propranolol treatment. Patients and Methods: We included prospectively cirrhotic patients with esophageal varices under primary prophylaxis (PP) and secondary prophylaxis (SP). The HVPG was measured at baseline and after a propranolol bolus (0.15 mg/kg intravenous). A patient was considered a good-responder if HVPG decreased to 12 mmHg or 20% from baseline. Patients then received oral propranolol (heart rate titrated). Poor-responders under SP were also included in a variceal band ligation program. After at least 3 months, a second hemodynamic study was conducted. Results: Fifty-six patients were included (36 SP and 20 PP). Response rate was similar (32.1 and 41.9%, P=0.7) and the Pearson's correlation coefficient was 0.61 (P=0.001). In 81.4% patients, the first study predicted the response status of the second. Six patients rebled on follow-up between the studies, all of them were poor responders to intravenous propranolol. Conclusion: A single hemodynamic study using intravenous propranolol seems to predict chronic response to propranolol. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.